Affordable Care Act Scene 2 - Insurance Premiums

Parent Cafe
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But on the individual market, only a very small fraction of people could possibly have grandfathered status. Reported stats are that 40-65% of people on the individual market leave their plans each year. So let’s be conservative, go with the lower figure (40% - we’ll take a sample of a 1,000 plan members as of March 2010. As of April 2011, 600 of those members remain. In another year, another 40% leave, and in April 2012, there are 360 left; by April 2013 there are 216 remaining. Of course the insurer has continued to sell plans and others have come in, but none of them have grandfathered status.</p>

<p>Now of that 216, let’s say half are available for subsidies on the exchange. They’re going to switch – the subsidy system not only gives them a lower rate, it essentially guarantees future rate stability if their income remains stable. So now out of the original grandfathered pool of 1000, you have 108 left - barely over 10%.</p>

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They were underwritten 4+ years ago. People don’t stay “healthy” forever – if they did, they wouldn’t need health insurance. Nor do people get younger. </p>

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It doesn’t matter whether they go to the exchange or buy direct from the company – everyone who is on the individual market in a non-grandfathered plan is now in a single risk pool.

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<p>I dunno about that. Why would a low-income college student not get health insurance? It would cost them almost nothing.</p>

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<p>The rest of the analysis is correct, but this part assumes facts not in evidence. Every year 40% of the plan members quit-- but we don’t know that it’s not the same 40% each year. It could be that 60% of the plan members are stable and never change, and 40% change every year. I doubt that, but it’s likely that people who have been on the plan for five years would be more likely to re-enroll than people who have been on the plan for one year. Very likely some of those people don’t like the bother of changing.</p>

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<p>You’d start by looking at this map:
[Multi-State</a> Plan Program and the Health Insurance Marketplace](<a href=“http://www.opm.gov/healthcare-insurance/multi-state-plan-program/]Multi-State”>Multi-State Plan Program and the Health Insurance Marketplace)</p>

<p>Multi-state does not mean that plan is written by its own terms to allow the person to go to any state for treatment; it means that the insurer has committed to selling on the exchanges in all 50 states over the next several years (I think 30 states in year #1). </p>

<p>However, if an insurer needs to have a presence in multiple states, it also needs to develop networks in each state, so its much more likely that there will be in-network providers.</p>

<p>Also, I’ve posted above that I’ve already confirmed that the Blue Card program lives on, and that it is still available to buyers of the BS PPO in my region in California. That doesn’t mean the same is true for every BCBS-affiliated plan – but it wasn’t that hard for me to check.</p>

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<p>Some states do have a search on their exchange websites for out of state providers on the multi-state plans. I googled and the first one I found was in Louisiana. You can put in practice area to see which doctors are in network in different states. For example, I put in a search for cardiologists within 5 miles of Baltimore and it came back with 200 cardiologists within the multi-state network.</p>

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<p>The in-state vs. out-of-state thing is not NEW. When my son went off to college in 2001, there was no law that said that his California policy had to afford coverage in New York. Because I had my kids on individual policies, I dropped my son’s policy at the time in favor of the university-provided policy. When he moved back to California, he got a job that provided insurance. (I think in hindsight that it was technically a mistake to drop my son’s policy, but only because the college plan was not that good – but it didn’t matter, as my son didn’t get sick). </p>

<p>When my daughter went off to college, I read the plans more carefully. The college plan only paid up to $5000 in benefits, so my daughter took the college plan and switched her to a California plan with a $5000 deductible. I also contacted the insurer, Blue Shield, to report that she was in college - we had to fill out a specific form and also send proof of enrollment to them. </p>

<p>I honestly don’t see what’s changed other than parents now focusing more attention on an issue, and MORE choices and options for the college student than before. (Plus better-quality, albeit costlier, insurance offered directly to students through the universities).</p>

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<p>Just to keep track of what I have learned so far - correct me if I am wrong:</p>

<p>If mom or dad have health insurance that is ACA compliant, they have to use their plan for students under 26. </p>

<p>People under 26 can be married and still on parents health plan.</p>

<p>People making less than 10,000 a year do not qualify for subsidies on exchange. Medicaid an option for these people. </p>

<p>Every member of family can go on exchange to buy own policy with a possible subsidy, as long as parents do not have health insurance from work. </p>

<p>Out of state kids under 26- ? </p>

<p>You do not have to buy on exchange, but if eligible for subsidy or tax rebate, you should. Same policy on insurer website or ehealth will not be eligible for subsidies. </p>

<p>Do not take subsidies up front if possible to owe penalty for not meeting income requirement max of 400% over poverty line for you or family. </p>

<p>All ACA compliant plans have no lifetime caps.</p>

<p>Every plan should be ACA compliant, on or off exchange by ? date</p>

<p>If you had a plan and kept it since then with no price increases or change on plan, you can keep it. </p>

<p>Yes, I am confused. I have read every post, too, in these last few ACA threads. </p>

<p>If I am confused and have been following this daily here since this summer, you better believe the general public is confused. We basically have Calmom who might moonlight as a Navigator…and we are still muddling through these details.</p>

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<p>I have a grandfathered plan that I can keep. I haven’t decided what to do yet. Maryland required most of what the ACA required anyway so the plans are not very different.</p>

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<p>Through Kaiser, my husband and I have a grandfathered individual plan. We have a separate grandfathered plan for my son 23 - it was cheaper than adding him to our plan and there was not, and is not, a requirement that we do so. My older son, 27 has a grandfathered plan through Blue of California with a global network. None of the premiums went up more than usual for the upcoming renewal - in fact, I think the percentage was less than in many previous years. However, we are exploring whether we’d be better off through the exchange. Our complications: my employer will pay for me, but no one else. My husband is self-employed and it’s difficult to predict income. My 23 year old graduates this spring and I guess will not be considered a dependent on our 2014 tax return. And no idea where he’ll be living. My older son is in grad school out of the country - and is currently covered by Sweden. So many variables!</p>

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<p>Calmom, so I noticed the Anthem exchange plans have multi-state in their names. What the heck does this mean? Are there out of state providers in network and how do you identify them?</p>

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<p>Thanks for the responses on out of state coverage. There is one policy only that is considered multi-state offered in our state right now. It’s not a very good plan because we really wanted a PPO and it’s an EPO. </p>

<p>I did love our old plan. It covered out of state, etc. My main issue with ACA is the lack of choice. I’m perfectly happy to pay more because I know I needed great insurance with my kid but so many insurers have left our state or reduced their offerings, that the coverage really sucks now compared to my old plan.</p>

<p>Makes me wonder if a new supplemental insurance market will pop up to offer people insurance to cover the gaps in this ACA insurance. The lack of PPO is the thing that drives me nuts with this new ACA insurance. I understand this is different in other states but ours is one with a very small amount of insurers and plans.</p>

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<p>This is not correct. There are a variety of options for students under the age of 26. For just one example, a 23-year-old student who is not the dependent of his parents-- a grad student with a fellowship, for example-- might buy his own policy.</p>

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<p>Oh. My bad then. Clearly there’s no problem. As long as you and your family are covered. Silly me</p>

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<p>I certainly don’t think the ACA is perfect by any stretch of the imagination. I’m not even convinced it’s good, but the lack of choice is a state issue. I’m sure the feds would have loved to be able to mandate that insurers opt in and provide excellent networks but that is the job of the states and some clearly “handle” the insurance companies better than others. Of course, some states are perfectly fine with offering poor choices because they would prefer for the program to tank altogether.</p>

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<p>So, is it really okay to blame states, insurance companies, IT developers, and dumb people who thought they could keep their crummy insurance? Next up, seems to be mean employers who throw people off their work provided plans. Is it just a coincidence that all of this is happening as the ACA takes effect? Perhaps, so.</p>

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<p>I could say exactly who I blame 100% but this is not the place for it. </p>

<p>Since I’m in a state who managed to get several different insurers on board with competitive rates and no issues with limited networks, I don’t think it’s a stretch to blame the states who have not done this.</p>

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<p>I can’t specifically blame the states though given a lack of evidence one way or the other. I personally think it’s the result of increased cost and a smaller pool of applicants that is driving insurers from some of these states. I would love to see what insurers say as the reason - if it is lack of customers, ACA, or states themselves. However, right now they’re being cast as the villains in this thing so I think they’re likely to keep a low profile. At this point, I’m just more concerned about finding good insurance like I used to have and less concerned with the political argument. That will be something I can concentrate upon when I go vote.</p>

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<p>poetgrl, you wrote, “I see this college age kid issue as a huge problem…”</p>

<p>I interpreted this to mean that the issue is a huge problem because of its scope, that is, many college age students who want to be insured, or whose parents want them to be insured, will encounter problems with the ACA. So I wanted to figure out what the scope of the problem is.</p>

<p>It seems that college-age students will have problems if all of the following things are true:</p>

<p>Their parents want to keep them on the parents policy, and</p>

<p>Their parents are buying insurance on the individual exchanges, and</p>

<p>They are going to college out of state, and</p>

<p>Their parents live in a state where individual insurance policies do not cover out-of-state health care</p>

<p>I say this is not a huge problem because the number of students so affected will be small. Not because the issue is unimportant for the students who are affected. It’s a problem, and should be addressed. It’s not the most glaring problem.</p>

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<p>I guess I wasn’t as clear with this question, cardinal fang.</p>

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<p>As long as NOT a dependent on parent, an under 26 year old with parents who have access to job-based health insurance CAN get marketplace options with possible subsidies. </p>

<p>If parents have job based health insurance, an under 26 year old who is dependent on parent’s taxes CANNOT get subsidies on exchange. </p>

<p>Would that be correct? </p>

<p><a href=“https://www.healthcare.gov/can-i-keep-my-child-on-my-insurance-until-age-26/#question=if-a-child-under-26-can-be-covered-under-a-parent-s-policy-can-she-get-lower-costs-on-marketplace-insurance-based-on-income[/url]”>https://www.healthcare.gov/can-i-keep-my-child-on-my-insurance-until-age-26/#question=if-a-child-under-26-can-be-covered-under-a-parent-s-policy-can-she-get-lower-costs-on-marketplace-insurance-based-on-income&lt;/a&gt;&lt;/p&gt;

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<p>Here’s the thing, CF. Many of your “it’s not a problem” posts rely on the employer based plans remaining in place and remaining the same.</p>

<p>My guess is that very few employer based plans are going to look any different than the individual plans when it’s all said and done. Insurance companies are going to stream line.</p>

<p>Your employer plan might be “grandfathered” but it doesn’t mean your employer is going to stick with that soon to be prohibitively expensive plan.</p>

<p>I don’t know why on earth anyone would assume any differently. Don’t say it’s because that’s what “they” said. That won’t fly.</p>

<p>“They” said a lot of things.</p>

<p>I see the entire system in each state being made up of plans just like those being offered on the individual market when it’s all said and done.</p>

<p>As a universal donor under the current system: meaning I’m paying 3X the premium and a higher deductible for less coverage and for less drug coverage, and I’m paying taxes to pay the subsidies for these plans, I have some opinions about how this is being done. Having some opinions about how ineffective this is in some areas is not a bad thing.</p>

<p>anybody who can’t see this has big problems is being willfully obtuse, in my opinion. Even the designers are saying there are massive issues. </p>

<p>Once the employer piece comes online, it’s just more complicated, not less. And the last thing this thing needs is more moving parts.</p>

<p>In the meantime, states are scrambling to force insurers to allow people to stay on cancelled plans, etc… It’s not just a problem, it’s a big problem.</p>

<p>That’s not political, by the way, that’s just some adminstrative commentary, like saying, the line is too long at the DMV. The post office is not profitable. etc… If you cannot say what is not working, you are not going to be able to make it work.</p>